In the structure of digestive diseases, a proportion of 5.1 to 9% belongs to chronic pancreatitis (CP). With these ailments, the pancreas is affected, the inflammatory process begins. As a result, degenerative changes occur in the organ . Initially, the pathological process can occur in the tail of the pancreas, its head or middle part. The outcome of the disease is damage to the entire organ. Some people with chronic pancreatitis eventually die. Mortality in the world averages about 11%.
More about the disease
So what is chronic pancreatitis? With this term, specialists designate a whole group of pancreatic diseases. For all ailments, the following features are characteristic:
- phase-progressive course with episodes of acute pancreatitis;
- focal, segmental or diffuse lesions of the pancreatic parenchyma with subsequent replacement of connective tissue;
- changes in the duct system of the organ;
- the formation of cysts, pseudocysts, stones and calcifications;
- development of endocrine and exocrine insufficiency.
The fact that there are various types of disease is evidenced by the International Statistical Classification of the tenth revision. Chronic pancreatitis ICD-10 is divided into:
- CP of alcoholic etiology (code K86.0);
- other CPs - infectious, recurring, recurrent, unspecified etiology (code K86.1).
The most common causes of chronic pancreatitis
Most often, the disease occurs due to alcohol abuse for a long time. In men, chronic pancreatic pancreatitis can develop if they drink over 15 years. In women, the likelihood of an ailment increases with the abuse of alcohol for more than 10 years.
Alcohol is not the only factor contributing to the appearance of chronic pancreatitis. The cause of the disease may be smoking. Substances that enter the lungs with smoke penetrate the blood and spread throughout the body, have a negative effect on all internal organs, including the pancreas.
Other causes of the disease
Other factors causing chronic pancreatitis (ICD-10 code 86.0 and 86.1) include:
- fatty food abuse, prolonged protein-free nutrition;
- various diseases of the gastrointestinal tract (neoplasms, cholecystitis, etc.);
- overweight, obesity;
- taking certain medications (Azathioprine, Furosemide, Prednisolone, synthetic estrogens, Erythromycin, Ampicillin, etc.);
- infection with viruses (cytomegalovirus, hepatitis B virus, C, etc.).
Studies conducted in recent years have shown that there is hereditary chronic pancreatic pancreatitis. This is an autosomal dominant disease with incomplete penetrance (with a different frequency of gene manifestation in the carrier phenotype). In sick people, hereditary chronic pancreatitis manifests itself quite early. However, the final stage occurs later than with other forms of the disease.
Forms of pancreatitis
There are various classifications of the disease. One of them is a list of the following forms of chronic pancreatitis:
- Recurrent. It occurs in 55-60% of cases. With this form, periods of remission are replaced by exacerbations of the pathological process.
- Constant pain. This form is detected much less often (in 20% of cases). With it, patients complain of constant pain, localized in the upper abdomen and radiating to the back.
- Pseudotumor (icteric). The frequency of occurrence of this form of chronic pancreatitis is 10%. The pathological process is characterized by the development of inflammation in the head of the pancreas and compression of the common bile duct.
- Painless (latent). The form is detected in 5-6% of cases. The pain with the disease is mild or not felt at all. Dyspeptic disorders periodically occur due to a malfunction of the pancreas.
- Sclerosing. With this form, pain occurs in the upper abdomen. They intensify after meals. Pain is accompanied by nausea, loose stools, weight loss. When conducting an ultrasound, specialists notice a decrease in size and densification of the pancreas.
According to the Marseille-Roman classification, there are such forms of pancreatitis as calcifying, obstructive, parenchymal and fibrosis. With the first of them, an uneven lobular lesion of the pancreas is observed. Pseudocysts, cysts, calcifications, stones appear in the ducts. What is obstructive chronic pancreatitis? With this kind of disease, the internal organ is affected evenly. Stones do not form, obstruction of the main pancreatic duct is observed. With the parenchymal form in the parenchyma, foci of inflammation develop. Calcifications are not formed, the duct system is not affected. Fibrosis is characterized by the replacement of the parenchyma of the internal organ with connective tissue. Due to this process, exo- and endocrine failure progresses.
Symptoms of the disease
Speaking about what chronic pancreatitis is, it is worth considering the signs of this ailment. In the early stages during periods of exacerbation, seizures are observed. They are characterized by pain in the epigastric region. In most cases, they radiate posteriorly. Herpes girdle is much less common. In people suffering from chronic pancreatitis, seizures occur due to exposure to provoking factors. They are the intake of fatty foods, alcoholic and carbonated drinks.
The disease is also characterized by dyspeptic syndrome. Approximately 56% of sick people report nausea and vomiting. In 33% of cases weight loss is observed, in 29% - flatulence, in 27% - a decrease in appetite. With an ailment, symptoms such as general weakness, fatigue, and reduced working capacity may also appear.
The course of chronic pancreatitis
Specialists distinguish 4 stages in the development of the disease:
- Preclinical stage. At this stage, sick people do not notice symptoms of chronic pancreatitis. The disease is often detected by chance during an ultrasound scan or computed tomography of the abdominal organs.
- The stage of initial manifestations in the development of such an ailment as chronic pancreatitis. Adults at this time begin to suffer the first symptoms of the disease. The duration of the stage can be several years. In some cases, the disease progresses very quickly.
- Stage of development of constant clinical symptoms. Patients show signs of endocrine and exocrine failure. People eat very little, complain of abdominal pain.
- The final stage. The pains become less pronounced. People noticeably lose weight. At the final stage, various complications of chronic pancreatitis arise due to atrophy of the pancreas, endocrine and exocrine insufficiency. One of them is cancer of the named internal organ.
Depending on the characteristics of the development of chronic pancreatitis, a mild course, a moderate degree and a severe course of the disease are distinguished. With a mild course, periods of exacerbation rarely occur (1-2 times a year). The pains are mild. The functions of the pancreas are not disturbed.
What is chronic pancreatitis of moderate severity? This is a disease in which 3-4 exacerbations per year are observed. They are longer than with a mild course of pancreatitis. In sick people, body weight decreases. Exocrine pancreatic function is moderately reduced, pancreatic hyperenzymemia is observed.
In severe cases of the disease, exacerbations are frequent and prolonged. Pain is accompanied by severe dyspeptic syndrome.
Treatment of the disease: goals and necessary measures
In chronic pancreatitis, therapy is prescribed to achieve the following goals:
- reduction of clinical manifestations of the disease;
- relapse prevention;
- reduction in the likelihood of complications of the disease.
Specialists prescribe non-drug treatment, drug therapy to their patients. If necessary, surgery is performed. Treatment of chronic pancreatitis in adults can be carried out both at home and in the hospital. An indication for hospitalization is the transition of the disease to the stage of exacerbation, because it is during this period that the patient’s life is threatened and parenteral administration of drugs becomes necessary.
Non-drug treatment
In the treatment of chronic pancreatitis, nutrition plays an important role. With severe exacerbations, hungry days are shown (1-3 or more) and heavy alkaline drink. According to the testimony, parenteral or enteral (the introduction of nutrients into the colon using a special probe) is prescribed. Thanks to this measure, it is possible to stop the secretion of the pancreas, intoxication decreases and the pain syndrome becomes weaker.
After the normalization of the condition, sick people are transferred to oral nutrition. Meals should be frequent, fractional. The daily menu is made up of mucous soups, vegetable purees, and liquid mashed milk porridges. From drinks stewed fruit, jelly, weak tea, mineral water, rosehip broth are allowed.
Be sure to exclude the following products:
- causing flatulence;
- incorporating coarse fiber;
- stimulating the production of digestive juices;
- rich in extractive substances.
Is it possible to have fish and meat broths, mushroom and strong vegetable broths, canned foods, smoked meats, sausages, fatty fish and meat, fried foods, raw fruits and vegetables, pastries, pastries, brown bread in chronic pancreatitis? All these products are prohibited in the exacerbation of the disease, so they should be discarded. You also need to remove spices, ice cream, alcohol from your menu.
During remissions, the diet changes slightly. People with a diagnosis of chronic pancreatic pancreatitis are allowed to eat pasta, raw vegetables and fruits, soft mild cheeses, and baked fish. Mashed soups can be replaced with ordinary vegetarian soups (cabbage should be excluded from the ingredients). Porridge can be crumbly, thicker.
Pharmacotherapy of chronic pancreatitis
The task of drug therapy in the first stage is to ensure the functional rest of the pancreas. This is achieved by:
- Reception of large doses of modern polyenzyme agents. These drugs include Mezim-Fort, Creon, Pancytrate.
- Maximum inhibition of acid gastric secretion using histamine H2-blockers (Ranitidine, Famotidine) or proton pump inhibitors (Omeprazole, Esomeprazole). Drugs are administered parenterally or taken orally.
- The introduction of "Octreotide " or "Sandostatin. " These drugs are synthetic analogues of the hormone somatostatin. Thanks to them, hypertension in the duct system of the pancreas decreases, and due to this, pain is relieved and stopped.
If therapeutic measures aimed at reducing pancreatic secretion do not have an analgesic effect, doctors prescribe non-narcotic or narcotic analgesics. “Analgin”, “Ketoprofen”, “Paracetamol” - any remedy for chronic pancreatitis can be prescribed by a doctor from the first group of drugs. Of the drugs related to narcotic analgesics, Promedol, Tramal, Fortral can be selected.
Treatment of chronic pancreatitis in adults may also include multienzyme replacement therapy. Indications for its use are the excretion of more than 15 g of fat per day with feces, diarrhea, and a rapid decrease in body weight. Poly-enzyme preparations are Abomin, Forte-N, Creon, Pancreatin, Festal, Pancreoflat, Digestal, Wobenzym.
Surgical treatment of the disease
In some cases of chronic pancreatitis, surgery is required. Indications are:
- pain that does not stop with drugs and diet;
- the presence of abscesses and cysts in the pancreas;
- obstruction of the bile ducts, which cannot be resolved using the endoscopic method;
- duodenal stenosis;
- fistulas in the pancreas with the development of pleural effusion or ascites;
- suspected cancer, not confirmed cytologically or histologically.
"Chronic pancreatitis, symptoms and treatment in adults" is an important medical topic that needs attention. This is an insidious disease, a progressive and irreversible process. However, treatment is still necessary. It allows you to extend the life of sick people, eliminates the unpleasant symptoms inherent in chronic pancreatitis. For example, subject to dietary recommendations, refusal from alcohol, and proper drug therapy, patients live up to 10 years. Half of those who do not seek medical help and continue to drink alcohol, smoke, eat incorrectly, die before this time.